Monday, August 26, 2013

Being able to digitally submit clinical quality measures (CQMs) to Medicare is one of the big promises of health IT for physicians and providers — and it’s still coming, along with other administrative simplifications.

But digital CQMs have been put to good use on the ground by some of the 17 Beacon Communities, the Office of the National Coordinator for Health IT argues in an issue brief. As the ONC and the Centers for Medicare & Medicaid Services finalize novel eCQMs for Medicare, in the areas of clinical care, care coordination and outcomes, here are three lessons from the Beacons on using quality measurements.

1. Beyond billing.

One common complaint from some physicians has been that particularly older EHR software systems are mostly designed for documentation and billing, with analysis tools being limited and not very usable.

Nowadays, providers are increasingly able to put their EHRs to use measuring their patients’ trends and their clinical performance, which can help develop a culture of improvement — providers turning to their data to scrutinize their care quality.

Through the Crescent City Beacon Community, in New Orleans, 17 providers worked with payers, vendors and other partners to start standardizing digital clinical data, with the goal of using the local health information exchange as a source of clinical quality measures.

Before they can do that, the health data is being validated. Data accuracy is especially important in a city where thousands of patients’ paper-based medical histories were lost to the floods of Hurricane Katrina.

The community-wide HIE will eventually be put to use reporting quality measures, offering community dashboards, provider performance and Meaningful Use reports.

The HIE is also currently deploying a software offering the ability to track patients and coordinate their care management across settings.

2. Aligning CQMs with value-based payments.

Much as Farzad Mostashari, MD, has heralded the decline of fee-for-service (often Tweeting #FFSdemise), only a minority of the healthcare services rendered in the U.S. are currently reimbursed through some type of accountable care or valued-based contract.

Still, healthcare made accountable or measured for value is happening, such as in Indiana. Through the Central Indiana Beacon Community’s Quality Health First program, the Indiana Health Information Exchange offers analytics and patient summaries for docs — showing them, for instance, all patients due for preventative screenings — to help them develop intervention and management programs for patients with chronic diseases.

Fee-for-service’s “misaligned incentives” resulted in a culture of health organizations often only reluctantly sharing patient data with unaffiliated providers, if not “hoarding” the data by default, and that’s resulted in poorly coordinated care for some patients being served by primary care doctors, specialists, hospitals and other providers. And that’s in addition to patients having to navigate healthcare finances from separate providers.

In Bangor, Maine, the small city where Stephen King lives, the Bangor Beacon Community in large part incentivized collaboration for the care of the region’s most vulnerable, with clinicians and care managers meeting to discuss disease management strategies, and robust HIE services performing the bulk of the data management.

For those patients, hospital admissions decreased 42 percent, emergency room visits by 43 percent, and walk-in care visits decreased by 75 percent over the course of 2011 and 2012.

With the goal of tracking the quality of care particularly for diabetes, heart disease, COPD and asthma, the collaborative approved data definitions, revised operational terms, identified regional target goals, and created common EHR patient encounter forms and workflow processes. Powered by Maine HealthInfoNet, the statewide HIE, the providers use a data registry that’s automated with their EHRs and sends them patient summaries.

The Bangor Beacon was successful with multi-organization quality metrics, the ONC concluded, in part because the “third-party centralized disease registry fostered a simplified, less competitive environment for negotiating data sharing agreements.” It also meant independent checks of data integrity.

The nation's top sustainability accounting nonprofit has issued new accounting standards for several health care subsectors, including biotechnology and pharmaceuticals.
The American National Standards Institute authorized the Sustainable Accounting Standards Board (SASB) to develop sustainability accounting standards to help publicly listed corporations report sustainability issues to investors and the public.
The SASB is in the process of setting sector-specific standards for the disclosure of environmental, social and governance (ESG) issues in SEC filings for 80 industries across 10 economic sectors. The new SASB provisional standards released this month are aimed at industries in the health care sector, including biotechnology, pharmaceuticals, medical equipment and supplies, health care delivery, health care distributors and managed care.
I think the standards, based on dozens of specific metrics, are well conceived as drafted thus far. Such information never has been standardized in a way that could properly inform investors, so the emergence of the SASB’s standards sets a high and uniform bar for how companies must share information. There is no doubt among sustainable investors that such information will relate directly to share value.

Product focus for biotech and pharmaceuticals standards
For the biotech and pharmaceuticals industries, companies must disclose ways they offer medicines to high-priority countries, recalls, unused product takebacks and safety issues, such as adverse side effects. Companies must discuss clinical trial safety protocols and any legal or regulatory fines or settlements therein. They must divulge how product prices compare to the Consumer Price Index. Fines or settlements for false advertising, corruption and poor manufacturing practices also must be revealed, while employee recruitment, retention and training programs must be elucidated. Product traceability, manufacturing energy and water use, and waste procedures also are measured.
Other sustainability topics for the biotech and pharmaceutical standards address supply chain management, consumer access, safety, employee relations, marketing, pricing, corruption, counterfeiting and natural resource and energy conservation.

Interesting health care delivery standards
I find the standards for health care delivery intriguing. They address quality of care issues, such as health care acquired infection rates, patient satisfaction, ratings on clinical process and outcome domains, and excessive serious reportable events.
These companies also must share their strategies for facilitating access for low-income patients, including including alternative pricing mechanisms, billing and pricing frameworks. Patient privacy procedures must meet a high standard. Employee turnover and talent recruitment and retention strategies also are assessed, as are incidents of fines and settlements for Medicare and Medicaid fraud. In the environmental arena, energy use and waste generation are evaluated, while companies must reveal strategies for how climate change risks may affect business operations.
Both the health care delivery and managed care subsectors must discuss access, privacy, transparency, fraud, employee relations, improved outcomes, plan literacy and performance, energy and waste efficiency, and climate change impacts on human health.

Managed care industry disclosure zeroes in on cost
Specific standards pertinent to managed care relate to cost and revenue schemes that enable access to care, claim denial rates, grievance rates, Medicare plan rating and employee retention rate.
Clarity in pricing and coverage is assessed, as is the privacy and security of customer data. Regarding medical care, enrollment in wellness programs and the coverage of preventive services is highly valued.

A good start
It is encouraging to see the breadth and depth of these accounting standards.
Considering the breadth of reporting systems, such as those from the Global Reporting Initiative and the International Integrated Reporting Council, the value of the SASB’s disclosure protocols will help investors to understand the material risks and opportunities of the companies they may own.